Vitamin D supplementation is a cost-effective intervention after posterolateral lumbar fusion: a systematic review. Issue 1 (21st January 2023)

• Record Type: Journal Article
• Authors: Patel, Dhiraj; Lippel, Matthew; Lunardini, David; Monsey, Robert; Ziino, Chason
• Is Part Of: Current orthopaedic practice. Volume 34:Issue 1(2023)
• Page Start: 9
• Page End: 15
• Publication Date: 2023-01-21
• Subjects: pseudarthrosis -- cost-effectiveness -- vitamin D deficiency -- posterolateral fusion; Orthopedics -- Periodicals; 616.7005
• DOI: 10.1097/BCO.0000000000001188
• Languages: English
• ISSNs: 1940-7041

Abstract

Abstract : Background: This study investigated the role of preoperative supplementation of 25(OH)D, a precursor of the active form of vitamin D, as a cost-effective strategy to decrease pseudarthrosis rates and overall healthcare burden after posterolateral fusion (PLF). Previous literature has emphasized the importance of vitamin D in bone health maintenance, spinal health, and outcomes in spinal fusion. Inadequate preoperative 25(OH)D levels may increase pseudarthrosis rates after PLF. Thus, a cost-estimation model was developed to determine the cost-effectiveness of both selective and nonselective 25(OH)D supplementation in PLF. Methods: Prevalence and cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean, lower, and upper bounds of 1-year cost-savings were calculated for both supplementation scenarios. Results: Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost-savings of $10, 978, 440 ($9, 969, 394 to $11, 987, 485) per 10, 000 PLF cases. Nonselective 25(OH)D supplementation of all PLF patients was calculated to result in a mean cost-savings of $11, 213, 318 ($10, 204, 272 to $12, 222, 363) per 10, 000 cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where revision PLF costs exceed $781.89 and prevalence of 25(OH)D deficiency ≥0.612%. Nonselective supplementation is cost-effective in clinical scenarios where revision PLF cost ≥$198.09 and prevalence of 25(OH)D deficiency ≥0.1645%. Conclusions: This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce overall healthcare burden after PLF. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the relatively lower cost of 25(OH)D supplementation compared with serum assays. Level of Evidence: Level III